Provider Demographics
NPI:1063437952
Name:KISNER, HARRISON MANGUM (MSW, LISW-CP)
Entity type:Individual
Prefix:MR
First Name:HARRISON
Middle Name:MANGUM
Last Name:KISNER
Suffix:
Gender:M
Credentials:MSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7C CLEVELAND CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2414
Mailing Address - Country:US
Mailing Address - Phone:864-360-4341
Mailing Address - Fax:864-239-6968
Practice Address - Street 1:7C CLEVELAND CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2414
Practice Address - Country:US
Practice Address - Phone:864-360-4341
Practice Address - Fax:864-239-6968
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0064531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ327878205Medicare UPIN